Tuesday, January 29, 2008

Why Don't Adults Get Vaccinated?

It's kind of depressing to keep reading about how our healthcare system fails to do the basic preventive tests and interventions that doctors and researchers know that can keep us healthy and lead productive lives. Here's another example in Time magazine's article Why Don't Adults Get Vaccinated?

A survey of 7000 adults found that most could only name the flu vaccine and that the hepatitis A, B, the shingles vaccine, the pneumococcal vaccine, the diphtheria, tetanus, and pertussis vaccine, weren't mentioned as easily.

Excerpts from the article:
  • Just 2% of adults have had the new combo shot for tetanus, diphtheria and pertussis (better known as whooping cough), even though pertussis rates in adolescents and adults have soared in the last 20 years. The disease, a major child killer before the childhood vaccine was introduced, can cause coughing so forceful it breaks a patient's ribs or leaves him vomiting.
  • Despite clamorous public debate and high-profile media coverage about the first cancer vaccine, which protects against the human papilloma virus, only about 10% of young women reported receiving at least one dose of the three-dose vaccine.
  • Vaccines should be a cornerstone of preventive medicine. "They can prevent serious illness and death. They can save money and help keep us healthy, and at work and able to take care of our families, says Schuchat, who is also director for the CDC's National Center for Immunization and Respiratory Diseases. "We obviously have a lot of work to do and it involves literally rolling up our sleeves."
What perhaps is more disturbing is that many adults aren't vaccinating their children.

These reports only illustrate the increasing importance that you must take charge of your health and ask and even demand preventive tests and interventions you need to stay healthy and live longer as it is clear that our healthcare system won't do it for you.

Thursday, January 24, 2008

Alzheimer's Disease - Searching for Preventive Treatments

The New York Times article Finding Alzheimer's Disease Before a Mind Fails illustrates the challenges facing doctors, researchers, patients, and families on finding preventive treatments, which do not currently exist, as well as challenges to help those afflicted with the illness. This is the last article in a six piece series which identified the six killers in America, heart disease, cancer, stroke, chronic obstructive pulmonary disease (emphysema), diabetes, and Alzheimer's.

The series was an excellent review of the challenges facing us and many of the shortcomings of our healthcare system in providing the right preventive care consistently and routinely to keep us healthy and living longer. It seems like we all take it for granted that our healthcare system is the worst among industrialized countries in keeping us healthy.

Personally, I see these problems as unacceptable and this shocking disparity gives me the motivation to educate everyone on what they must do to stay healthy and live longer.

Tuesday, January 22, 2008

Being a Doctor (or Lawyer) Isn't Prestigous

Doctors and evidently lawyers are less satisfied than in the past a New York Times article found. Fewer individuals are heading into these fields because many see better monetary and fame potential in working with startup companies or financial services. Other reasons include a generational difference where individuals want the ability to be creative and authentic to themselves and pursue those fields or start up companies that allow them to thrive. This current cohort was described as:

  • they want immediate rewards — not exactly the mentality that will fuel a student through years of medical school, a residency and additional training for a specialty.
  • “Their attention span, everything, is instant feedback: quick, quick, quick,” Mr. Coleman said. “Apprenticeship, these kids don’t want to do it.”
The numbers of new applicants for medical school has fallen to 42,000, down from 46,000 in 1997, but better than 33,000 in 2003.

As fewer people apply to medical school, current doctors are less satisfied and leaving.

  • As of 2006, nearly 60 percent of doctors polled by the American College of Physician Executives said they had considered getting out of medicine because of low morale, and nearly 70 percent knew someone who already had.
  • Complaints about managed care crimping doctors’ income and authority over medical decisions are nothing new, but the problems are only getting worse, several doctors said.
  • One doctor responding to the American College of Physician Executives survey wrote: “I find it necessary about once every month or two to stay in bed for 24 to 48 hours. I do this on short notice when I get the feeling I might punch somebody.”
  • Increasing workloads and paperwork might be tolerable if the old feeling of authority were still the same, doctors said. But patients who once might have revered them for their knowledge and skill often arrive at the office armed with a sense of personal expertise, gleaned from a few hours on www.WebMD.com, doctors said, not to mention a disdain for the medical system in general.
With many of the best and brightest heading off to startup their own companies or joining the ranks of the financial services for big bucks and perhaps fame, fewer are becoming doctors. As the baby boomers enter retirement and as Americans continue to live longer with many chronic illnesses, there will be fewer doctors available to treat patients. Potentially a doctors' shortage may occur as current doctors are tired of the current system and are quitting as a shortfall of new doctors occurs.

Many of my colleagues will not advise their children to become doctors because the hassles of practicing have been far more onerous than the satisfaction of caring for others.

What does this mean to you? Various possibilities. You may need to wait longer as fewer doctors will be available while at the same time the time you spend with them is shorter. Another possibility is that doctors from outside the United States continue to immigrate to make up the shortfall meaning that you will be treated by non-US medical school graduates. Perhaps doctors and their care will be outsourced. You might travel overseas to have expensive surgeries performed, which is already occurring for many Americans.

This is not to say you should feel sorry for doctors. There still is something very sacred and precious about having the privilege of helping a complete stranger. It is one of few professions where an individual, a doctor, can walk in a room and the other person can reveal anything which may not be known by his most intimate companion.

Nevertheless if trends continue, this observation could end up being a true healthcare crisis. You will feel the doctors' pain in a real way.

Thursday, January 17, 2008

Majority of Americans Support Mandatory Health Insurance

With the nominations for the Republican and Democratic parties underway, healthcare has been a hot topic. In this country, 47 million Americans are uninsured. The proposed plans by the candidates vary. One of the stickier issues is whether everyone is required to have health insurance. A survey of adult Americans found that
  • 80 percent of Democrats
  • 52 percent of Republicans
  • 68 percent of Independents
supported the idea that everyone should have insurance. For those that could not afford it that , they felt that the government should help.

This makes absolute sense. As we all get older, the need for health insurance and healthcare increases. Answering this question, whether health insurance is essential or optional is only one of many questions we must answer if the healthcare system will be reformed in a meaningful way. Hopefully we will see it in our lifetimes. Until then, make sure you are doing the right things to stay healthy.

Monday, January 14, 2008

Newer Isn't Better - Cholesterol Medication Not Effective

A report found that Merck's cholesterol lowering medication, Zetia, did not show any benefits.

While this report was surprising, it illustrates an important fact. Newer medications aren't necessarily better than previous therapies. The active ingredient in Zetia, which is also found in Vytorin, lowers cholesterol, but the released clinical trial showed that it didn't slow the clogging of arteries. This is why clinical trials need to be done to prove therapies are effective. While one can assume that lowering cholesterol can improve clogging of arteries, one needs to have proof.

If you go to the ZETIA website, there is the following disclaimer.

  • Unlike some statins, ZETIA has not been shown to prevent heart disease or heart attacks.
So, when your doctor prescribes you a medication, particularly if it is one that has been heavily marketed, ask him the following.
  • Why this particular medication?
  • Is this one proven to save lives (i.e. lowering cholesterol isn't as important as preventing heart attacks).
  • Are there others that are less expensive and proven?
Try not to ask your doctor about medications that you saw on television. Research shows that doctors more often than not will prescribe it for you.

Caveat emptor
- Let the buyer beware.

Thursday, January 10, 2008

Shocking, But Not Surprising - US Healthcare System Ranks Last

In a Health Affairs article which looked at how well 19 industrialized countries kept their citizens healthy, the United States ranked last. Which countries ranked best (in order of best to worst performance)?
  • France, Japan, Australia, Austria, Canada, Denmark, Finland, Germany, Greece, Ireland, Italy, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, the United Kingdom and the United States.
The authors looked at how these countries did on decreasing the death rate among those under age 75 between 1997 to 1998 and 2002 to 2003. Specifically, were countries better than others decreasing the death rate by improving the healthcare system by timely effective delivery of care?

  • In 1997–98, the U.S. ranked 15th out of the 19 countries on this measure—ahead of only Finland, Portugal, the United Kingdom, and Ireland—with a rate of 114.7 deaths per 100,000 people. By 2002–03, the U.S. fell to last place, with 109.7 per 100,000. In the leading countries, mortality rates per 100,000 people were 64.8 in France, 71.2 in Japan, and 71.3 in Australia.
Had the performance improved to the levels by the top three countries, 75,000 to 101,000 Americans would still be alive today.

Sadly, our country's poor performance is not a surprise. In our country, the healthcare system as a whole provides the known preventive tests and interventions proven to save lives only 55 percent of the time. Slightly better than a coin flip. As Americans pay more per capita for healthcare than any other country in the world, our system isn't the best at keeping us healthy. Unless you take the initiative and ask for tests and interventions that will keep you healthy for a long time, you might get the right care half the time. Are you willing to risk it?

Wednesday, January 9, 2008

Simple Lifestyle Changes Extend Lives

Perhaps hardly surprising but a study of 20,000 Britons found that four simple lifestyle habits potentially extended life by 14 years. The group that decreased their chance of death simply didn't smoke, had five servings of fruits and vegetables, exercised regularly, and drank alcohol in moderation.

  • The study included healthy adults aged 45 to 79. Participants filled in a health questionnaire between 1993 and 1997 and nurses conducted a medical exam at a clinic. Participants scored a point each for not smoking, regular physical activity, eating five servings of fruits and vegetables a day and moderate alcohol intake.
  • Until 2006, the researchers tracked deaths from all causes, including cardiovascular disease, cancer and respiratory diseases. People who scored four points were four times less likely to die than those who scored zero, the research showed.
Simple small changes made a big difference. If five servings of fruits and vegetables a day is too hard, start with more humble goals, perhaps two servings twice a week and build up to the goal of five servings everyday.

Why don't people adopt these practices? Maybe because the things that make the most sense often aren't particularly exciting or sexy, but require a little common sense, a little bit of work to make it happen, and then persistence to make it a healthy habit.

Tuesday, January 8, 2008

Health Savings Account - Another Way to Fund Retirement

The Wall Street Journal ran a piece discussing how health savings accounts (HSAs) are being used by individuals as another way of saving for retirement and not to fund their future healthcare costs but as . Financial services firms and investors are finding that the ability to fund the account tax-free, allowing funds to grow tax-free, and then spent tax-free dollar for dollar on qualified medical expenses aren't the HSAs only attraction. Since dollars in an HSA don't need to be spent on medical expenses and can be withdrawn at age 65, with the funds subject to ordinary income taxes, many instead are using the HSA as another retirement account.

  • "HSAs offer a triple tax advantage," says Bert M. Halliday, a first vice president and senior adviser at Merrill Lynch & Co., who leads a team of financial advisers specializing in these accounts.
  • Money in the accounts can be invested in stocks, bonds, mutual funds and certificates of deposit. Merrill is managing about 20,000 HSAs for clients, mainly doctors, lawyers and accountants, says Mr. Halliday.
  • "It's a great perk" for people approaching retirement, says Betsy Billard, a private wealth adviser with Ameriprise Financial Inc.
  • Maxing out on annual contributions to an HSA can be an astute financial strategy for the well-heeled who can afford to cover any out-of-pocket medical expenses without dipping into their HSA.
  • However, HSAs are less favorable for lower-income unhealthy people because out-of-pocket expenses increase with the amount of health-care services you use, and the tax advantages aren't as great for people in lower brackets. In this scenario, paying more up-front in premiums is likely to be a more cost-effective option.
What's the catch? You need to know when you must get care to stay healthy and when you can safely skip. Unlike auto insurance where a high deductible may prevent you from getting dents or dings fixed for your car, your body doesn't have replaceable interchangeable parts.

It seems more like the HSAs were geared to those in higher income and the current participation seems to reflect that demographic. As HSAs are the focus of many of the Republician presidental candidates as a way of addressing our healthcare crisis, the question is is this the right plan?

Sunday, January 6, 2008

Chinese Herbal Supplements Not Safe

The FDA found that an erectile dysfunction herbal supplement had the active ingredient from the prescription medication Viagra. The herbal supplements is available under the names Super Shangai, Strong Testis, Shangai Ultra, Shangai Ultra X, Lady Shangai and Shangai Regular.

This unfortunately is not surprising. Due to loopholes in the current legislation, manufacturers of herbal and dietary supplements are not obligated to prove to FDA that their products are safe or effective. Manufacturers do not need to register with FDA that they will market a new product. Companies also must make sure that their marketing plans are not misleading. The laws that regulate herbal and dietary supplements is far different than those covering over-the-counter medications and prescription medications.

What does this mean to you? Be very careful when taking a herbal or dietary supplement as manufacturers are accountable to no one. Check with your doctor. Consider finding out more about potentially dangerous herbals at Consumer Reports, the Natural Standard database, and at Medline Plus.

Thursday, January 3, 2008

Free Drug Samples Don't Help Those in Need

An article in the upcoming issue of the American Journal of Public Health found that free drug samples distributed by drug reps are not being given to those in need, but rather to patients who have health insurance. Findings from the report include:
  • about 12 percent of all Americans have received at least one free sample
  • 13 percent of those with insurance were given a sample, while about 10 percent of those uninsured for all or part of the year got one, a statistically significant finding
  • 72 percent had income above 200 percent of the federal poverty line, while 28 percent had incomes below that level
The study also found that the recalled pain reliever, Vioxx, was in 2002, the most frequently distributed medication even though the medical indications for its use should have been limited to those at high risk for stomach ulcers and bleeds. It was learned shortly afterwards that Vioxx increased the risk of heart attacks.

Why is this important to you? The author of the study initially thought that it was possible that the free medication samples had a good benefit which was to help provide a safety net to those with inadequate or no health insurance. However, this article only reinforces the perception that drug companies are out to market their medications, which isn't always in your best interest.

Tuesday, January 1, 2008

What You Must Do to Stay Healthy

The American healthcare system only consistently delivers the right preventive care 55 percent of the time. As a result, tens of thousands of Americans die prematurely from avoidable deaths because simple interventions weren't done. Doctors are increasingly busy and may not have enough time to tell you all you need to know to stay well. One study showed that a doctor working full time would need an extra day to counsel patients on what steps they should do to keep healthy. As a result preventive screening tests for cancers like breast cancer, prostate cancer, and colon cancer, which are leading causes of death, aren't performed routinely and regularly for those who need it. With more patients paying higher deductibles and co-pays, you must know what you should ask for and then get it done.

For breast cancer screening, this means women at average risk should have a mammogram at age 40. Men at average risk should begin screening for prostate cancer at age 50. Both genders should have colon cancer screening, either a sigmoidoscopy with annual stool testing or a colonoscopy starting at age 50. You may need to check with your doctor if you are at higher risk as you may need to be screened earlier or more frequently. A major misconception is that only individuals with a family history are at risk for cancer. While they are at higher risk, the vast majority of new cancer cases occur in individuals without a family history.

The same preventive screening tests and interventions also apply to other problems like high blood pressure, high cholesterol, and diabetes. Do you know what the ideal blood pressure is? How often should you have it checked? When should you be screened for diabetes? Are you at risk?

Even if you exercise regularly, are at a healthy weight, don't smoke or drink, it doesn't mean you can or should skip these important preventive steps. Identifying and addressing problems early increases your chance of living longer and staying well.

The healthcare system doesn't reliably remind you when you should get these tests done. Your doctor may not have enough time to remind you what to do. Increasingly you are paying more for healthcare. Find out what you need to do to stay well. It's your money. It's your life.

Go to www.davisliumd.com to get the preventive guidelines for adults under the free download section.


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